|
Hi, we're Oscar. We're hiring a Payment Policy Associate to join our Payment Integrity team.
Oscar is the first health insurance company built around a full stack technology platform & a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family.
About the role
The Payment Policy Associate manages & executes all payment policy activities, including organizing, scoping, investigating, & resolving payment policy issues. Responsibilities also involve delegating & prioritizing project tasks effectively. This work relies on internal team research & a thorough understanding of Oscar's claim infrastructure to draft & update payment policies accurately.
You will report to the Manager, Payment Policy
Work Location:
Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture & our mission.
If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.
You must reside in one of the following states: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote
Pay Transparency:
The base pay for this role in the states of California, Connecticut, New Jersey, New York, & Washington is: $88,800 - $116,550 per year. The base pay for this role in all other locations is: $79,920 - $104,895 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program & annual performance bonuses.
Responsibilities
- Provide subject matter expertise & in-depth understanding of Payment Integrity internal claims processing edits, external vendor edits & Oscar reimbursement policies.
- Analyze data mining & process monitoring to pinpoint claims payment issues, then define the scope & steps for policy remediation.
- Examine industry standards to confirm claim payments align with industry best practices, internal policies, & regulationsboth industry-wide & Oscar-specific.
- Respond to internal & external inquiries & disputes regarding policies & edits.
- Document industry standard coding rules & draft recommendations on reimbursement policy language & scope.
- Ideate payment integrity opportunities based on a deep knowledge of industry standard coding rules. Translate into business requirements; submit to & collaborate with internal partners to effectuate change.
- Attend regulation update meetings & relay information to team members, providing training & education as needed.
- Perpetuate a culture of transparency & collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate.
- Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever issues are escalated & assigned by leadership.
- Compliance with all applicable laws & regulations
- Other duties as assigned
Qualifications
- A bachelor's degree or 4+ years of commensurate experience
- 4+ years of experience in claims processing, coding, auditing or health care operations
- 4+ years experience in medical coding
- Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)
- Experience with reimbursement methodologies, provider contract concepts & common claims processing/resolution practices.
Bonus Points
- 3+ years of experience working with large data sets using excel or a database language
- Knowledge management, training, or content development in operational settings
- Process Improvement or Lean Six Sigma training
- Experience using SQL
This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.
At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves & find both belonging & support. We're on a mission to change health care -- an experience made whole by our unique backgrounds & perspectives.
Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, & experience. Full-time employees are eligible for benefits including: medical, dental, & vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life & disability insurance, & paid wellness time & reimbursements.
Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicants disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.
Artificial Intelligence (AI) Guidelines: Please see our AI Guidelines for the acceptable use of artificial intelligence during the interview process at Oscar.
California Residents: For information about our collection, use, & disclosure of applicants personal information as well as applicants rights over their personal information, please see our Notice to Job Applicants.
|
